MEDICARE: CONSUMERS PHARMACY INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	0053008445	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1449239	OTHER	IL	NABP

General Provider Information

NPI Number	:	1902801087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONSUMERS PHARMACY INC.

Provider Business Mailing Address
First Line	:	1 SURREYBROOK PLAZA
Second Line	:
City	:	SAUK VILLAGE
State	:	IL
Zip	:	60411
Country	:	US
Telephone Number	:	708-757-4030
Fax Number	:	708-757-4728

Provider Business Practice Location Address
First Line	:	1 SURREYBROOK PLAZA
Second Line	:
City	:	SAUK VILLAGE
State	:	IL
Zip	:	60411
Country	:	US
Telephone Number	:	708-757-4030
Fax Number	:	708-757-4728

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN J HEBDA
Credential	:	RPH
Telephone Number	:	708-757-4030

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	08/22/2020

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